I believe that my nose has extremely thick skin. It obscures my underlying cartilage and nose structure

   I think that your nose can be refined with a closed rhinoplasty even with the skin as it is.Kenneth Hughes, MDBeverly Hills, CA

Generally speaking, the skin issues are the hardest issues to deal with in performing a rhinoplasty and are certainly the most challenging. However, there are various techniques that have been employed to a greater or lesser degree. The first involves thinning the nose of extra subcutaneous fat. A some what more dangerous approach has been gently scoring the underlying skin to make it more malleable. This is a dangerous step used only in the hands of very experienced surgeons cause of the risks of retractions or even skin loss. Occasionally, excess skin can be shifted laterally so as to appear tighter. The use of Accutane in the past used to help some patients cause it made the sebaceous glands atrophy. But it had it's own risks with liver toxicity and birth defects in women.Finally, the use of steroid injections and 5-FU injections coupled with taping has gone a long way in improving the final results in patients with thick skin.

 Just because you have skin doesn't mean you can't have a very good result from rhinoplasty you can achieve a more attractive and masculine nose depending  if you go to a very experienced rhinoplasty surgeon. The skin can be thinned and carriage added to give better definition to the nose. Nothing in the future yet to thin skin further.

From your photo, you appear to have a wide, amorphous nose. The skin is on the thick side, but the texture appears to be good. There are surgical techniques that can improve thick skinned individuals. This technique would be an Open Structure Rhinoplasty, in which the the cartilage can be sculpted and cartilage grafts can be use to support the nasal structure and the skin can sometimes be debulked. However remember that the skin can can not be replaced or changed. You appear to be a good candidate for the open structured approach. Consult with an experienced expert in rhinoplasty such as a facial plastic surgeon.

 A full set of pictures or an in-person examination are required to determine the amount of thickness of the skin versus the thickness of the lower lateral cartilages of the nasal tip. Suture techniques, cartilage removal, and cartilage grafting techniques are all used to help give more projection, definition and refinement to the tip when needed. For more information and many examples, please see the video and the link below

Rhinoplasty in patients with thick skin can be challenging.  Often we use cartilage grafts - especially in the tip, to accentuate the underlying structure so changes we want can be seen through thick skin.  Sometimes we will also thin the skin and tissue on the undersurface during an open rhinoplasty surgery.  I would recommend you see a board certified facial plastic surgeon or general plastic surgeon that specializes in rhinoplasty.

There are methods that are commonly used to thin the skin as well as the framework to refine the nose in a very natural way without obvious tell-tale surgical signs. 

 Hi, based upon the attached photos the nasal bridge and tip cartilages themselves look wide as well as the skin appearing a bit thick.  Laser resurfacing can thin the skin but IMHO this probably wpon't thin the nose that much overall.  A Rhinoplasty would be required.  

The quality of a patient's skin can be improved with expert treatment and good care. In fact, I frequently recommend that patients with thick skin consult with one of the aestheticians in our clinic before rhinnoplasty surgery to improve their results. If you're asking about thinning the skin as the sole treatment for a patient with a wide tip, no this is not possible; ask a patient with thin skin and a wide tip. There are techniques to improve a nose like yours without causing a "pointy tip".

Thanks for your question.  As rhinoplasty surgeons we all examine noses to determine the strength and thickness of cartilage as well as the thinness or thickness of skin covering the bone and cartilage.  It appears to me that you may have wide nasal structures that are amenable to refinement with a natural improved apperance of your nose.  I see good potential for change and enhancement for you.  Choose carefully your rhinoplasty surgeon and discuss options together so that you are comfortable with the suggestions made to you.  If you like the ideas presented and review photos of other patients as well as "imaged" photos of yourself then I would recommend that you consider proceeding.  Good luck with your decision and enjoy your resulst if you chose to go ahead with rhinoplasty.